Provider Demographics
NPI:1326810516
Name:ROYSE, ELIZABETH A (CRNA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:ROYSE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:WALSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:814 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:IL
Mailing Address - Zip Code:61856-2154
Mailing Address - Country:US
Mailing Address - Phone:217-520-5567
Mailing Address - Fax:
Practice Address - Street 1:814 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:IL
Practice Address - Zip Code:61856-2154
Practice Address - Country:US
Practice Address - Phone:217-520-5567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209029278367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered